You will need a written treatment plan. Treatment depends on diagnosis. You will need a diagnosis. You will want three diagnoses:
- An ICD-10 diagnosis, this is the category code diagnosis from the World Health Organization for all medical and psychiatric diagnoses.
- A DSM-5 diagnosis, this is the specialty psychiatric diagnostic system from the American Psychiatric Association.
- A case conceptualization diagnosis from family systems therapy, this will provide the treatment framework diagnosis.
I have a Diagostic Checklist for Pathogenic Parenting on my website with four symptoms, two are an a-b.
- Attachment pathology toward a normal-range parent.
- Five specific narcissistic personality traits in the child’s symptom display.
- A persecutory delusion, a fixed and false belief in supposed “victimization” by the normal-range parenting of the targeted parent.
If all three of these symptoms are present, then you and I are talking about the same thing. If all three of these symptoms are not present, then we are talking about different things.
Next, let’s turn to family systems therapy, the case conceptualization diagnosis. The pathology of concern is depicted exactly by Minuchin’s diagram: a cross-generational coalition and emotional cutoff. I have a whole video series on this on my website in the YouTube section: Foundations: Family Systems.
Can there be a cross-generational coalition (formation of sides) without a complete emotional cutoff? Yes, the coalition will create increased conflicts, but not a cutoff. The cross-generational coalition is bad, but it is not (yet) in the child abuse range if the three Diagnostic Indicators of pathogenic parenting are not present.
From a clinical psychology perspective, the worrisome issue is the addition of splitting pathology to the cross-generational coalition. That transmutes otherwise bad family dynamics into another level, spitting pathology does. It is a neurological symptom of complex trauma exposure that involves an extreme polarization of attitudes and perceptions – black-and-white; all good or all bad, no shades of grey, no middle.
Add splitting to the cross-generational coalition – that’s the pathology I’m talking about. What do you do if it’s not that, or not quite that? You will want a written treatment plan to fix whatever it is. For a treatment plan you will need a diagnosis, for a diagnosis you will need an assessment.
The quality of the assessment, diagnosis, and treatment plan is entirely dependent on the knowledge applied. No knowledge applied leads to misdiagnosis and mistreatment. Lots of knowledge applied leads to accurate diagnoses and effective treatment.
Family relationships during times of stress collapse into triangles, triangles are the unit of analysis in family conflicts. The conflict event is called a “breach-and-repair” sequence in child development (Tronick). If you understand the principles of the breach-and-repair sequence, then you can… repair… a breach to the relationship. Using knowledge of what conflict is and how to fix it.
Everything is organized around a treatment plan, a written treatment plan, for that you need a diagnosis (the treatment for cancer is different than the treatment for diabetes), and for that you need an assessment.
Now… what if the mental health person won’t provide you with a written treatment plan? Do you know why that is? It is because they have no idea what to do to fix it, they are incompetent and don’t know what they are doing. So when you ask for a treatment plan, they say, “no.”
The written treatment plan should have Goals, Interventions, Outcome Measures, and Time-Frames, Google mental health treatment plans and read the first two entries.
Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857